title: Do psychiatric comorbidities influence inpatient death, adverse events, and discharge after lower extremity fractures?
abstract: BACKGROUND
  Psychiatric comorbidity is known to contribute to illness (the state of feeling unwell/unable to rely on one's body) and increased use of healthcare resources, but the effect on inpatient outcomes in fracture care is relatively unexplored.
  
  
  OBJECTIVE
  Our primary null hypothesis is that a concomitant diagnosis of depression, anxiety, dementia, or schizophrenia is not associated with (1) discharge to another care facility rather than home after lower extremity fractures. Secondary study questions address the associations between psychiatric comorbidity and (2) longer inpatient stay and inpatient (3) adverse events; (4) blood transfusion; and (5) mortality after lower extremity fractures.
  
  
  METHODS
  Using the National Hospital Discharge Survey database, we analyzed a total estimated number of 10,669,449 patients with lower limb fractures from 1990 to 2007. Sixty-four percent were women, and the mean±SD age was 67±22 years. The prevalence in the study population was 3.2% for depression, 1.6% for anxiety, 0.6% for schizophrenia, and 2.9% for dementia.
  
  
  RESULTS
  A discharge diagnosis of psychiatric comorbidity was associated with a lower rate of discharge to home after accounting for an association with greater medical comorbidity (schizophrenia: odds ratio [OR], 5.6, 95% confidence interval [CI], 5.5-5.8; dementia: OR, 1.3, 95% CI, 1.2-1.3; depression: OR, 1.2, 95% CI, 1.2-1.3; anxiety: OR, 1.04, 95% CI, 1.02-1.06). Hospital stay was longer for patients with schizophrenia and dementia but shorter in patients with depression or anxiety compared with patients without any mental disorders. Schizophrenia was associated with more in-hospital adverse events and depression and anxiety with fewer events. A diagnosis of depression was associated with blood transfusion. Psychiatric comorbidity was not associated with a higher risk of in-hospital death.
  
  
  CONCLUSIONS
  Optimal inpatient management of patients with lower extremity fractures should account for the influence of psychiatric comorbidities, dementia and schizophrenia in particular.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.forename: Arjan G J
authors.initials: AG
authors.lastname: Bot
authors.forename: Mark S
authors.initials: MS
authors.lastname: Vrahas
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000401:mortality; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D012307:Risk Factors